‘Go To’ Sports Podiatrist Explains Running Injuries to Southern Regional AthletesFrom Simple Shin Splints to Femoral Neck Stress Fractures
Dr. John F. Connors is a podiatrist, not of the run of the mill variety, but of the running variety. He specializes in sports podiatry. More specifically, he focuses on runners, especially middle and long distance runners.
Over the course of his 20-plus year career Connors, who has offices in New York City and Little Silver, has worked with many elite athletes not only from the United States, but from countries around the world – Kenya, Ethiopia, Brazil, Mexico, Russia and Romania. He’s offered his services at multiple Olympic Games, including Sydney, Australia, in 2000 and London in 2012, where he was one of the doctors at the Nike hospitality tent.
He’s been called “the go to guy in the entire country” when it comes to runners’ injuries. His patients include Shannon Rowbury, the American record holder in the 1,500 meters; Molly Huddle, the American record holder in both the 5,000 meters and the 10,000 meters – setting the latter mark in the Rio Olympic Games – and Kenyan Patrick Makau Musyoki, the former world record holder in the marathon.
So what was Connors doing on Monday morning, addressing a crowd of about 80 cross country and track athletes in the Southern Regional High School auditorium? It turns out that Connors, who grew up on LBI, treats Southern Regional School District Superintendent Craig Henry and is friends with members of the district’s coaching staff.
The doctor – who, by the way, has run almost 20 marathons of his own – gave the students an hour-long PowerPoint presentation titled “Running Injuries – Diagnosis, Treatment & Prevention.” At times he slipped into heavy medical nomenclature, talking about things such as patellofermoral pain and femoral neck stress fractures. But much of his talk addressed running injuries in clear and simple language that both the Southern athletes and casual weekend warriors could understand.
There are two basic families of running injuries, said Connors. The first is acute, a.k.a. sudden, which the doctor said accounts for only about 5 percent of his patients. The other is chronic.
“That’s the majority of injuries I see, chronic, caused by overuse or stress applied over a period of time,” he explained.
For a while Connors sounded like a chiropractor, saying many chronic injuries spring from the issue that “your body’s not aligned the way it should be.”
“Injury is due to a lack of stability in the foot and ankle.”
At a practical level, Connors warned against running regularly on roadways.
“Don’t run on an uneven surface,” he said while flashing a picture of a runner on a roadway.
He said roadways not only create misalignment because of their sloped surfaces, but create shock injuries as well.
“When you run, you’re creating forces four times your body weight. Macadam can’t absorb the impact shock.”
Grassy surfaces, Connors said, are much preferable for training purposes. Beach sand, too, is good, as long as you run on the packed surface near the water. That sand absorbs impact. Don’t, he said, run in deep sand, which creates strain on the muscles when removing the foot from it.
He went on to discuss running form.
“How should you land, on your heel, mid-foot or forefoot?” he asked the student athletes.
Alas, some would have flunked a quiz, with one saying the heel and another the forefoot.
“You should use a mid-foot stride; the mid-foot absorbs better. Try to teach yourself how to land mid-foot.”
Later in his presentation Connors ticked off a checklist of the “perfect running form.” Look ahead. Land mid-foot. Run parallel to the line of progression. Keep hands at waist level. Relax hands. Relax shoulders. Don’t bounce, and run tall. He especially warned against having a vertical bounce.
“A vertical bounce fatigues a runner. A lot of kids waste so much energy.”
Connors also stressed that runners have to keep their entire bodies strong, not just their legs, in the interest of a good alignment. Core training, he said, is especially important.
“A study showed a 74-percent reduction in injuries to females who did core strength training.”
You don’t have to join a gym to increase core strength.
“You don’t have to lift weights, you can use your own body weight.”
The doctor recommended the FOCUS T25 workout for core training.
Indeed, Connors considers core training so important that he recommends runners run four days a week and spend the other three working on their core strength.
Runners, said Connors, experience injuries in three different areas: the lower leg, the knees and the hips. He spent most of his time on Monday morning discussing the first.
There are three basic types of leg injuries – shin splints, stress fractures and exertional compartment syndrome. The first is by far the most common.
“Ninety percent of the kids I see have posterior – on the inside – shin splints.”
Shin splints are pretty easy to diagnose, according to the doctor.
“There’s pain when you press on the muscle,” he said. “And kids will tell me, ‘It hurts when I start running and then the pain goes away.’”
Shin splints are caused by irritated and swollen muscles, often resulting from overuse. Stress fractures, a.k.a. hairline fractures, on the other hand, affect the bone. If that sounds more serious, it is, and the symptoms are accordingly worse.
“When you have a stress fracture, you have pain when you start, and it intensifies so much you have to stop,” said Connors. “The only people I know who can run through a stress fracture are the Kenyans.”
Something shin splints and stress fractures have in common is they both are caused by overuse.
“Stress fractures are caused when the muscle pulls on the periosteum, the outer coating of bones,” said Connors. “I like to treat stress fractures aggressively. Just resting, not running for a month, doesn’t work. You have to break down scar tissue; I like to break it down and get rid of it.”
A stress fracture diagnosis can be confirmed with an MRI.
Both conditions can be helped by EPAT – extracorporeal pulse activation treatment. A machine generates a set of acoustic pressure waves that are delivered by a wand-like applicator to an injured area to increase blood flow, thus accelerating the healing process.
“The machine breaks up scar tissue,” said Connors. “We (Connors and his associate) do this all day long. Shin splints, stress fractures, all go away with this treatment.”
Exertional compartment syndrome occurs when the sheet covering a muscle doesn’t expand along with a muscle. Its symptoms differ from those of shin splints and stress fracture.
“When you start to run, there is no pain at all,” said the doctor. “As you get into your run, eight, 12, 15 minutes, you’ll feel weakness, foot numbness. You stop a minute and then get back running for eight, 12, 15 minutes and you have to stop again.”
Exertional compartment syndrome, said Connors, is often misdiagnosed.
“You can’t use an MRI or X-ray to diagnose it. You have to use a compartment test where you stick a needle into the area, run on a treadmill, and then stick the needle in again to make a measurement. It can be fixed with a minor surgical procedure where you open the sheet to allow the muscle to expand.”
Other treatments employed by Connors include creating platelet-rich plasma and aminox injections. The former is a procedure in which a patient’s blood is taken and spun in a centrifuge, separating the platelets, which are then reintroduced to the body.
“Platelets are the healing component of your blood,” he said.
The latter employs stem cells, which Connors said helps with regenerative healing.
Knee pain was the next issue the doctor discussed.
“I see a lot of knee pain, particularly in girls. All of the muscles around the knee should be of equal strength. In female runners I often see weakness in the inner muscle. Instead of the kneecap going straight up and down, it glides off to the side. Again, you just can’t take a month off.”
Physical therapy is a common solution to knee pain.
Hip pain is often caused by a femoral neck stress fracture. The femoral neck is, as the old song says, where the thighbone is connected to the hipbone. If untreated, said Connors, surgery may be required, which can put a runner on the shelf for a year.
Young athletes often have hip pain because, as they are growing, the femur grows faster than their tendons. Such a problem can be suspected, said Connors, when a runner feels pain running uphill or downhill. It is a condition that can be helped with physical therapy.
Male and female runners often deal with different problems.
Estrogen, said the doctor, tends to create fat, not muscle.
“Girls must train harder to get stronger,” said Connors. “Girls have to work harder than their counterpart, boys.”
Estrogen, he said, also produces loose ligaments in female athletes, and they tend to have more iron deficiencies.
Testosterone helps boys build muscle. But that advantage comes with an asterisk.
“Testosterone makes muscles tight, so boys have to pay more attention to their stretching.”
— Rick Mellerup